三级医院脑卒中出院患者居家护理模式的应用效果

目的探讨居家护理模式在三级医院脑卒中出院患者中的应用效果。方法便利抽样法选择2012年5-8月出院的脑卒中患者168例(观察组)及2011年5-8月出院的脑卒中患者173例(对照组),观察组采用居家护理模式实施护理,对照组实施常规护理,对两组患者相关指标进行比较。结果观察组患者平均住院日短于对照组,治疗依从性高于对照组,出院后30d日常生活活动能力评分高于对照组,出院后30d内吸入性肺炎发生率与再住院率低于对照组,出院满意度高于对照组,各指标差异均有统计学意义(P0.05或P0.01)。结论居家护理模式能够改善脑卒中患者生活质量,实现脑卒中患者护理的专业性、持续性和延伸性,保证了脑卒中患者在出院后继续得到专业支持和帮助,是一种先进有效的延伸护理服务模式。     

三级医院重型颅脑外伤患者出院延伸服务模式的构建与实践

目的 探讨延伸护理模式在三级医院重型颅脑外伤患者中的构建与应用效果.方法 选择2012年1-12月出院的60例重型颅脑外伤患者,通过随机数字法分为研究组和对照组,各30例.研究组按延伸护理模式实施护理,并与实施常规护理的对照组进行比较.比较两组患者的平均住院时间、3个月内再住院率,出院后3个月内吸入性肺炎发、压疮和跌倒发生率及日常生活活动能力.结果 与对照组相比,研究组平均住院时间缩短[（20.36 ±4.33）d比（16.29 ±2.18）d]、3个月内再住院率降低（16.67％比3.33％）、出院后3个月日常生活活动能力评分升高[（30.08±9.32）分比（48.27±10.39）分]、出院后3个月内并发症发生率降低（吸入性肺炎、压疮、跌倒发生率分别为13.33％,13.33％,16.67％比0.00％,3.33％,3.33％）,差异均有统计学意义（P＜0.05）.结论 延伸护理模式能够改善重型颅脑外伤患者生存质量,实现了重型颅脑外伤患者护理的专业性、持续性和延伸性,保证了重型颅脑外伤患者在出院后能够得到专业支持和帮助,是一种先进有效的延伸护理服务模式.     

居家护理服务模式的构建

通过构建和应用居家护理服务模式,保证了患者在出院后能够得到专业支持和帮助,为临床提供了一种先进、有效的延伸护理服务模式,体现了护理的专业性、持续性和延伸性。     

对脑卒中患者的居家护理效果分析

目的探讨居家护理对脑卒中患者的护理效果分析。方法将48例脑卒中患者分为观察组和对照组,各24例。观察组实施出院后居家护理:健康教育、电话随访和上门访视等。对照组出院后不实施居家护理。比较两组患者出院后FMA和Barthel评分情况以及疾病知识掌握度和护理满意度。结果疾病知识掌握情况和护理满意度、FMA评分Ⅲ级及Ⅳ级比例、Barthel评分优良率均高于对照组(P0.05)。结论实施居家护理可以提高患者的疾病知识掌握度和满意度,改善其生活质量,值得临床推广应用。     

脑卒中吞咽障碍患者居家护理模式及效果评价

目的:构建脑卒中吞咽障碍患者居家护理模式并评价其效果。方法:选取脑卒中吞咽障碍患者78例为研究对象。采用计算机产生随机序列法将患者随机分为观察组和对照组,每组各39例。对照组给予常规健康教育,观察组在常规健康教育基础上给予居家护理服务计划和干预措施,干预12周后,评价并比较2组患者干预前后的吞咽障碍情况、神经功能缺损程度、营养风险、自理能力、日常活动能力、心理状态及康复依从性。结果:干预12周后,2组吞咽障碍功能较治疗前明显提高(P0.05),且观察组更优于对照组(P0.05)。干预后,观察组患者神经功能缺损、营养风险、抑郁评分明显低于干预前及对照组(均P0.05),观察组患者自理能力、日常活动能力、依从性得分均高于干预前及对照组(均P0.05);对照组各项指标干预前后比较除营养风险和抑郁评分外,其余各项指标差异有统计学意义(均P0.05)。结论:脑卒中吞咽障碍患者居家护理模式有较高的实用价值,对改善脑卒中吞咽障碍患者吞咽情况,提高患者生活质量,促进患者康复,实现医院-社区-家庭的无中断长期护理服务有重要作用。     

脑卒中病人居家康复护理研究进展

对脑卒中病人居家康复护理模式内涵及效果进行阐述,了解脑卒中居家康复护理现状,介绍脑卒中病人居家护理内容、干预方法及效果评价系统,为今后研究脑卒中居家康复护理提出建议。     

护理延伸服务在居家服务中的应用

总结92例护理延伸服务患者在居家服务中的应用。主要包括患者居家延伸服务与护理延伸服务满意度调查。认为护理延伸服务不仅能提高患者的满意度和生活质量,还可以构建和谐的护患关系、提高护理服务质量和树立优质护理品牌。     

脑卒中病人居家护理模式探讨

[目的]探讨更适合脑卒中病人的居家护理模式。[方法]选取80例脑卒中病人分为对照组34例和观察组46例,对照组出院后给予常规护理,观察组在常规护理的基础上采用加强健康宣教、改善居家环境等护理措施,护理4周后采用神经功能缺损量表(CSS)和焦虑自评量表(SAS)对两组病人的神经功能、焦虑心理、生活质量及并发症发生情况进行比较。[结果]护理4周后,观察组护理后CSS评分(12.75分±4.16分)、SAS评分(30.80分±5.01分)低于对照组(20.82分±5.10分,50.38分±5.79分),总体健康评分(80.25分±13.60分)高于对照组(64.35分±13.01分),观察组并发症发生率低于对照组,差异均有统计学意义(P<0.05)。[结论]加强健康宣教、改善居家环境等护理措施有助于改善脑卒中病人的神经功能与心理状态,提高病人的生活质量,减少并发症的发生。     

居家康复护理对脑卒中患者的护理研究进展

脑卒中患者居家康复护理的理念对于患者居住的环境、康复训练使用的器械、患者所能掌握的难易程度、同时包括医务人员所要付出的人力等方面都有不同程度的要求。因此如何降低脑卒中致残率和复发率,减少后遗症,提高患者生存质量,减轻家庭和社会负担,尽快回归社会是我们目前研究的重要方向。     

出院准备计划和居家中医护理在冠心病患者中的应用效果

【】 目的：探讨出院准备计划和居家护理在冠心病患者中的应用效果。 方法：选择2013年1月至2013年6月在我院因冠心病住院的患者90例为对照组,选择2014年1月至2014年6月在我院因冠心病住院的患者90例为观察组。对照组接受常规健康教育护理方式,观察组在对照组常规护理的基础上进行出院准备计划和居家护理,比较干预后两组的心境状态、治疗依从性。 结果：干预前,心境状态中的7个维度两组差异无统计学意义(P＞0.05);干预后在愤怒与混乱上两组差异无统计学意义(P＞0.05),在其他5个维度上差异有统计学意义(P＜0.05)。出院准备计划和居家护理干预实施后,观察组在遵医用药、合理休息、按时复查、合理饮食、戒烟戒酒、合理锻炼、预防感染等7个维度及总分评分上明显高于对照组,差异有统计学意义(t=5.224、6.035、5.942、4.993、4.798、5.648、6.498,P均为0.000)。结论： 对冠心病患者在常规健康教育的基础上实施出院准备计划和居家护理,能提高患者治疗的积极性,改善患者的心境状态,提高治疗依从性及生活质量。     

Quasi-experimental evaluation of a home care model for patients with stroke in China

Purpose: To evaluate the effectiveness of a modified home care model in China.

Methods: First-time stroke survivors were recruited from a comprehensive teaching hospital in China. Subjects in the intervention group (n?=?168) received modified home care involving detailed pre-discharge preparation and post-discharge follow-up lasting one month. The following outcomes were assessed at the end of follow-up: length of hospital stay, satisfaction with acute hospitalisation, medication compliance, complications and stroke-related re-hospitalisation. The outcomes were compared for the intervention group and a historical control group (n?=?173) who received routine care.

Results: Modified home care was associated with shorter acute hospitalisation (11.29?±?2.18 vs. 12.36?±?4.33 d, p?=?0.03), higher compliance [161 (95.83%) vs. 92 (53.18%), p?=?0.004] and ability to perform daily activities (38.25?±?10.22 vs. 32.08?±?10.32, p?=?0.03), and a lower rate of re-hospitalisation [2 (1.19%) vs. 11 (6.36%), p?=?0.02].

Conclusions: Home care may be associated with higher quality of life and reduced dependency among stroke patients in China.

• Implications for Rehabilitation

• Home care can be effective method at improving the physical and psychological well-being of stroke survivors in China.

• The home care model in this study can improve health outcomes as well as reduce healthcare resources utilisation.

• Home care models for stroke survivors should be adapted to local healthcare policies and resources.

     

Comparisons of the cost-effectiveness among hospital chronic care, nursing home placement, home nursing care and family care for severe stroke patients

AIM: This study compared the cost and effectiveness of long-term institutional care and home care for stroke patients with severe physical disabilities. BACKGROUND: Whether home care is more economical or effective than institutional care for patients with chronic illnesses remains controversial when the cost of family labour is considered. Thus, decisions concerning the appropriate type of care setting for patients with severe chronic illness remain difficult. METHODS: From November 1995 to March 1996, 313 hospitalized stroke patients with severe physical disabilities treated at one of five hospitals in the Taipei metropolitan area were followed from the day of hospital discharge until the third month after discharge. These 313 patients were divided into four groups as follows: (1) 106 who were admitted to a chronic care unit in a hospital, (2) 60 who were admitted to nursing homes, (3) 60 who received professional home nursing care and (4) 87 who returned home without receiving professional care. The change of physical functional status in the patient was examined as the difference between activities of daily living (ADL) scores measured at discharge and at the end of the third month after discharge. RESULTS: Information on family costs for caregiving, including pay for long-term services utilized, labour costs for caregiving and out-of-pocket expenditures for miscellaneous materials was obtained during a weekly telephone interview. The results indicated that caring for patients in their own homes was not only more expensive but was also less effective in improving ADL scores than caring for patients in nursing homes and in chronic care units of hospitals. CONCLUSIONS: The results suggest that caring for patients with severe physical disabilities in institutions is more appropriate than caring of them at home.     

The meaning of quality of care in home care settings: older lesbian and bisexual women's perspectives

Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55–72 from Ontario, Canada, participated in semi‐structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers’ comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy.     

神经外科实施延续性护理的实践探讨

为了探讨延续性护理在神经外科患者出院后的应用效果,自2010年6月起对出院的脑部疾病患者实施延续性护理,实践证明,延续性护理对于神经外科患者出院后的护理管理具有重要意义,可以巩固其健康知识,提高用药的依从性,从而确保安全,同时也大大提升了患者满意度。     

奥马哈问题分类系统在居家脑卒中患者评估中的应用

目的探讨奥马哈问题分类系统在居家脑卒中患者评估中的应用。方法以奥马哈系统问题分类系统为依据,对176例居家脑卒中患者的护理问题进行分析、归类,找出患者存在的主要护理问题,为社区护理提供依据。结果居家脑卒中患者护理问题发生率超过85%的护理问题是与联络社区资源、药物治疗方案、循环、消化-水合、居住环境、营养和个人照顾,结论奥马哈系统问题分类系统在居家脑卒中患者评估中的应用,能够促进社区护理的评估和整体护理的实施。     

A cost-effectiveness analysis of home care and community-based nursing homes for stroke patients and their families

A prospective study designed for 336 hospitalized patients with stroke and their families, who were followed from the discharge day to the third month after being discharged, was carried out in order to compare the costs and effectiveness of home care with the community-based nursing homes for stroke patients with different physical function disabilities in terms of ADL scores and their families. The ADL scores of the patients with severe physical function disability did not improve with or without long-term care; however, the patients with moderate physical function disability were significantly improved at the end of the third month, even without interventions from long-term care. The family costs of the patients in nursing homes were substantially lower than the costs for the patients who stayed at home, and the relationship of the family costs of the patients cared for in their own homes was proportional to the patients'physical function status. The labour input from family caregiving accounted for at least 60% of the total family costs of the patients who stayed at home, and the paid for long-term care services accounted for at least 60% of total family costs when the patients stayed in nursing homes. The multiple linear regression demonstrated that the degree of caregiving from families was a predictor of the amount of the costs families incurred for patients with severe physical function disability; as a result the ADL scored on discharge significantly influenced the average total family costs for the patients cared for in their own homes.     

延续性护理在癌症出院患者中的实践研究进展

延续性护理是为满足出院患者实际需要而提供的一种有序、协调、不间断的医疗保健服务,近年来已逐渐成为癌症出院患者健康照护研究的热点。本文从延续性护理的概念、在癌症出院患者中的实践现状以及延续性护理对癌症出院患者的影响等方面对国内外研究进展进行综述,为下一步构建适合我国癌症患者的延续性照护模式提供理论依据。